Good to the Bone

By staff | May 1, 2006

The 76 million baby boomers in the United States are wildly different from one another. After all, that group includes Bill Clinton, Cher, Geraldo Rivera, Justice Clarence Thomas and rocker Pat Benatar. But there's something they all share, and they're vocal about it: aches and pains. The older this group... Read more »

The 76 million baby boomers in the United States are wildly different from one another. After all, that group includes Bill Clinton, Cher, Geraldo Rivera, Justice Clarence Thomas and rocker Pat Benatar. But there's something they all share, and they're vocal about it: aches and pains. The older this group gets, the more wear and tear their muscles and bones show.

Some of the most common complaints are back, knee, shoulder, foot or ankle problems. In fact, Americans made 31 million visits to doctors' offices for back problems in 2003. They made 19 million visits for knee problems, 14 million visits for shoulder problems, and 11 million for foot and ankle problems.

That's a lot of problems!

None of that escapes the attention of the American Academy of Orthopaedic Surgeons, which has noticed such a trend of injuries among baby boomers that they've given it a name: "boomeritis." In fact, the AAOS has joined with the National Athletic Trainers' Association in a campaign to "Prevent Boomeritis." What both groups hope to minimize are the banes of the aging frame: tendonitis, bursitis, arthritis and the sports injuries that catch up with this group of weekend warriors.

As people age, the musculoskeletal tissues change. Bones become more brittle, muscles weaken, joints stiffen. People get heavier, too, which puts even more stress on the body.

Baby boomers' musculoskeletal injuries happen for predictable reasons: normal wear and tear in tendons and joints, muscle loss, overuse of a particular joint, and old injuries that flare up again, often due to osteoarthritis. Osteoarthritis happens when the smooth, elastic cartilage on the ends of bones, which acts as a cushion, wears away and becomes rough. Then the joint that used to move effortlessly sticks, clicks or even grinds.

To treat the pain and swelling, the doctor might inject anti-inflammatories or prescribe them in pill or tablet form. They often prescribe physical therapy to improve joint flexibility, increase range of motion, strengthen bone and cartilage and reduce pain. If the patient is an athlete, the doctor may suggest substituting lower-impact sports. Sometimes it helps to apply ice several times a day to an affected joint. Elastic bandages, splints, braces, canes or crutches may be called for.

When conservative treatments don't work, there are three common surgical options.

In arthroscopy, a surgeon uses a small fiber-optic camera and an access tube, called an arthroscope, which is about the size of a pencil. With a couple of small incisions, the surgeon treats the problem, such as removing bone spurs, cysts, damaged cartilage or loose tissue fragments.

In joint fusion, pins, plates, screws or rods hold bones in place while tissue heals. In this case the joint will no longer be flexible, but sometimes that's preferable to the symptoms.

And in joint replacement, a surgeon replaces cartilage and bone with metal and plastic, creating an artificial joint.

Fortunately for boomers, some revolutionary procedures are making the aging process a little easier.

Arlyne Trelease, 73, recently went through knee-replacement surgery. The Sarasota great-grandmother had had knee pain for a couple of years. Her doctor, Daniel S. Lamar Jr. of Coastal Orthopedics and Sports Medicine in Bradenton, first treated her with cortisone injections. Like other orthopedic surgeons, Lamar tries more conservative treatments first whenever possible, but sometimes surgery is the best choice.

The good news is that in many types of orthopedic surgery, the instruments have gotten highly sophisticated and much, much smaller, meaning the incisions are smaller and so is the recovery time. The result is minimally invasive surgery, sometimes called atraumatic surgery.

About five weeks after she had knee-replacement surgery, Trelease says, she went outside to walk her dogs "and a neighbor said to me, 'I thought you were going to have surgery.' I said 'Hi, Bill,' and pulled up my pant leg and said, 'I did.' He couldn't believe it."

Trelease wasn't keen on the idea of surgery at first. But as a few years went by, wear and tear on her knee were worsened by osteoarthritis, and the pain got worse. And then she got hit by a car.

That was January 2004, in her 10th week working for the Manatee County Sheriff's Department as a school crossing guard. "These kids went through a red light and brushed me, and I fell," Trelease recalls. "I'm not sure exactly what happened. I guess I passed out for a little bit. But my knee was badly bruised."

The traumatic bruising compounded the arthritis that had degenerated cartilage in her knee, and Trelease decided to go ahead with the arthroscopic surgery recommended by Lamar.

Before her surgery, she could barely walk a mile. She would go to the store and hurt, she says, and tell herself she had to do something about it. After arthroscopic surgery, Trelease spent three days in the hospital, after which the results were evident. "I was really good from day five on," she says. "I've been able to go out shopping and do different things, and nobody can believe it."

"What we did was remove the diseased surfaces of the bone-the [ends of the] femur and the tibia-and replace them with metal and plastic," says Lamar, a Manatee High grad who's now an orthopedic consultant to the Tampa Bay Buccaneers, the Pittsburgh Pirates and the U.S. soccer team. "We're using relatively new technology, computer navigation that allows us to check to see that the metal and plastic are in perfect alignment so we can perfectly place the metal and plastic prosthesis. What we do is place trackers in the femur and the tibia at the time of surgery, and they send signals to the screen that we can see. The benefit to placing them precisely, besides that we're able to do a very good job, is that it also gives the part much better longevity," Lamar explains.

Sarasota resident Bill Wing had another common orthopedic problem. The trouble was his back, but the pain started in his leg.

The owner of Strudels & Cream bakery cafés and catering company, which bakes for Sarasota News & Books, among other businesses, Wing, 73, had retired from the baked goods business in New England and moved here. Then one thing led to another, and he was enjoying a second wind in the business when his body started to balk.

His leg began to hurt and grow numb. Before long, he had gone from being a marathon runner to somebody who had a hard time standing in line for a movie ticket. Eventually, he couldn't stand for more than five minutes at a time.

He sought help, but spent the next six months with few answers. "I went and had all these tests done-an MRI, some nerve tests, all kinds of X-rays-and then the doctor said maybe a chiropractor could help, or some massage therapy. I did that for a while, and nothing seemed to help."

Wing eventually was told he was a candidate for a back operation, but the traditional "open-back" procedure, with its four- to six-inch incisions down the back and often pain and mobility problems afterward, made him nervous. So he was happy to hear about another minimally invasive procedure, using small instruments and much smaller incisions.

Wing saw Dr. Thomas Sweeney of Southeastern Spine Center & Research Institute in Sarasota, who told him that the pain in his leg was actually caused by a protruding lumbar disc and a narrowing of the spinal column due to an enlarged joint, which pressed on nerves affecting his leg.

"When the little joints along the discs of the spine degenerate due to arthritis, the spine moves and is unstable," Sweeney says. "To compensate for this, the spine grows bone spurs in an attempt to stabilize itself." So Sweeney removed the spurs, checked to see that the nerves in Wing's spine were not compressed, then stabilized his spine by fusing it with screws and rods.

"I used to treat this with an open-spine surgical procedure," says Sweeney. "For that, you make long incisions on either side of the spine, and pull muscles out of the way with large retractors, which often damage them. So you correct the spinal problem but end up with a damaged back anyway."

Sweeney, a nationally recognized speaker on this type of surgery, uses an endoscope, or access portal, to repair the spine in cases like Wing's. "We pass a little tube through the skin on either side to get under the muscle and create a working space, where we use much smaller instruments to fuse the affected discs," explains Sweeney. "This way the muscles are not deprived of blood flow and not pressed on, which minimizes the damage. The result is less bleeding, less pain, less pain medication, less time in the hospital and less in recovery."

The day after surgery, Wing was out of the hospital and walking. He was back to work in a week-just desk work at that point, with no bending, lifting or twisting, but already visions of restaurants were dancing in his head. A year later, Wing is once again playing golf and running, plus working a demanding schedule, checking in with his food service operation in the Sarasota County administration building, his bakery café and his catering clients.

"I'm in perfect shape. I can do anything I used to do and more," he says.

And Arlyne Trelease is off to Oklahoma for a few months to visit one of her five children. She's looking forward to horseback riding and bicycling with her grandchildren, and next month, she's planning on doing the polka at granddaughter Jennifer's wedding.

TO LEARN MORE

For more information on the doctors or procedures in this story, go to www.southeasternspinecenter.com and www.coastalorthopedics.com.

The Web site for the American Academy of Orthopedic Surgeons is at http://orthoinfo.aaos.org. The AAOS provides educational services for musculoskeletal specialists and patients. Founded in 1933, the academy has about 24,000 members internationally.

IS IT OSTEOARTHRITIS?

Osteoarthritis can affect any joint in the body, with symptoms ranging from mild to disabling. A joint affected by OA may have pain and inflammation, swelling and stiffness, loss of range of motion, "sticking" and weakness.

Pain and inflammation. Without cartilage, bones rub directly against each other when you move. Joint pain usually develops gradually and may feel dull or aching. Pain may be worse in the morning and feel better with activity. Vigorous activity may cause pain to flare up.

Swelling and stiffness. The joint may stiffen and look swollen, enlarged or "out of joint." A bump may develop over the joint.

Loss of range of motion. Motion may be limited if bending the joint becomes difficult.

"Sticking" and weakness. Loose fragments of cartilage and other tissue can cause locking or "sticking" when you use the joint. The joint may lose its strength and buckle or lock.